The Usefulness of Over-the-Scope Clips for Managing Gastrointestinal Complications of Endoscopic or Surgical Procedures: The SAGA-OTSC Registry Study.

Background: The over-the-scope clip (OTSC) system enables full-thickness closure of gastrointestinal wall defects and has been used to address gastrointestinal complications of endoscopic and surgical procedures such as perforation, bleeding, and fistulae. This study aimed to evaluate the use of the OTSC system in managing these complications in Saga Prefecture, Japan. Methods: We retrospectively analyzed the clinical data of 23 patients who underwent OTSC system-based management for complications of surgical or endoscopic procedures between January 2020 and July 2024 across five institutions. All procedures were performed by expert endoscopists. Results: The mean patient age was 72.3 years and 10 were men. Indications for OTSC treatment included perforation (52.2%), fistula (21.7%), and bleeding (13.0%). Fifteen cases (65.2%) involved the upper gastrointestinal tract. The median duration from the onset of complication to OTSC application was 4 days. OTSC treatment was technically successful in 21 patients (91.3%). Mean procedure time was 39.7 min. Treatment failure occurred in two cases involving jejunal lesions. Seven patients including two technical failures (30.5%) required additional treatment (surgery or repeat OTSC). For patients who required additional intervention, the median duration from OTSC to further treatment was 21 days. The timing of OTSC treatment was not associated with treatment success or the need for further intervention. Conclusions: The OTSC system demonstrated a high success rate and favorable safety profile for managing gastrointestinal tract complications. However, early surgical intervention may be required in case OTSC treatment is applied for lesions of deep small bowel or large fibrotic defects.